Our primary goal is to provide the first comprehensive comparison of stroke incidence rates among blacks and whites in a metropolitan population of 1,299,901 of whom 187,806 are black. We will identify every hospitalized or autopsied stroke in the entire study population during one year of observation and in blacks over a two-year period. To estimate non-hospitalized strokes, we will monitor all seven hospital- based outpatient clinics; three University of Cincinnati affiliated family practice outpatient clinics; all cincinnati Public Health Clinics; 50 randomly selected general internists, family physicians, or neurologists; all emergency department visits; all death certificates; and a random sample of nursing homes. The estimated 2100 first-ever strokes (including 600 black cases) will be used to test the following hypotheses: 1) Compared to whites, blacks have a higher age- and sex-adjusted incidence rate of all stroke, cerebral infarction, spontaneous intracerebral hemorrhage, and non-traumatic subarachnoid hemorrhage. 2) The 30-day mortality following stroke and stroke subtypes is similar for blacks and whites. 3) The overall age-, sex-, and race-adjusted incidence rate and 30-day mortality for intracerebral hemorrhage and subarachnoid hemorrhage in Greater Cincinnati during 1993 will not be significantly different from 1988 figures. The long-term goals of our research group are to use this metropolitan population laboratory to monitor temporal changes in stroke incidence rates in blacks and whites. Factors likely to explain any racial, gender, or temporal differences in stroke incidence rates will be investigated. These data are crucial for developing more focused and effective public health efforts to prevent stroke.